Second opinion before surgery after an injury · Regenerative care · St. Louis

Told you need surgery after an injury?
Get a second opinion first

Before you agree to surgery after an injury, get a second opinion that confirms which structure hurts and why it has not healed. Surgery cannot be undone. At Regen.MD in St. Louis, the regenerative treatment we provide after an accident can be billed to your injury claim and carried on a lien, so the decision does not have to wait for a settlement.

Surgery is irreversible. Can you live with that?

An operation on the spine or a joint removes tissue, joins bones or adds hardware. None of it comes back out the way it went in. If the result is good, you keep it. If it is not, you keep that too.

So ask one plain question before you sign the consent form: if this goes badly, can I live with it? Then ask a second one. Was surgery the only option, or just the only one anyone offered you? The decision that cannot be undone belongs at the end of the list, after the ones that can.

Your body creates the healing. We are merely the catalyst.

Every treatment, surgery included, depends on your own cells to do the repair, and repair runs on a metabolic budget. High blood sugar, insulin resistance and constant low-grade inflammation shrink that budget. Poor sleep turns up the volume on pain. Months off work and an open claim keep stress hormones high, and stress feeds the same inflammation.

That is why two people in the same collision heal on different schedules. Most injuries finish healing; the ones that do not have usually stalled in the last stage of repair, when new collagen should replace the temporary patch and line up along the load. Why some injuries never finish healing shows where that stall happens.

An operation is a second injury. Placed into a body that could not finish the first repair, it starts at a disadvantage. So we measure the terrain first, from blood sugar and inflammation to sleep and load, and correct it while we treat the injured structure. What a regenerative practice actually contributes after an injury lays out the method.

Has anyone offered you the alternatives?

Between therapy and surgery sits a whole middle that most injured patients never hear about. At Regen.MD, that middle is the practice. Each option targets a structure the workup has confirmed and leaves surgery available later.

• Diagnostic workup. An exam read against your imaging, plus diagnostic blocks: numbing medicine at one joint or nerve. If your usual pain goes quiet, then returns as it wears off, that structure is the source.
• Image-guided platelet-rich plasma (PRP). Platelets from your own blood, concentrated and placed under ultrasound or fluoroscopy into the structure the workup identified. How we choose between platelets, marrow and fat.
• Bone marrow concentrate and microfragmented fat (Lipogems). Your own marrow or fat, for tissue that has lost more ground.
• Prolotherapy for loose ligaments that let a joint or a neck segment shift after a sprain or whiplash.
• Radiofrequency neurolysis when a diagnostic block, not a guess, confirms a specific nerve is carrying the pain. It quiets that signal for months while the terrain is corrected.
• Metabolic optimization. Labs, nutrition, sleep and, for specific repair problems, peptides chosen after the evaluation. This terrain work decides whether everything else holds.

Is the finding on my MRI what actually hurts?

Scans show wear in people who feel fine. A review of more than 3,000 people with no back pain found disc degeneration in 37% of 20-year-olds and 96% of 80-year-olds. The bulge on your report may have sat there quietly for years before the crash.

That cuts both ways. The insurer will say it was already there, and often it was. A worn structure carries less reserve, and an injury can use up the margin that kept it quiet. The same collision at thirty and at fifty-eight explains that margin. After whiplash, controlled blocks found the small facet joints of the neck were the pain source in 54% to 60% of people with lasting neck pain. On an MRI those joints look like ordinary aging.

So we test before we treat. A documented response to diagnostic blocks names the structure that hurts now, and it answers “it was already there” with findings.

How is regenerative care paid for after an accident?

You do not have to wait for your case to settle. When you have an open injury claim and an attorney, the regenerative treatment we provide is billed to that claim and carried on a lien, backed by a letter of protection your attorney signs. You can also pay at the time of service.

Health insurance rarely pays for orthobiologic procedures, a payer decision covered in why insurance rarely covers orthobiologics. Your injury claim is a different payer.

In Missouri, the health care provider lien law, RSMo 430.225 to 430.250, gives physicians and clinics the same lien rights as hospitals on your claim against the person who caused the injury. If you were hurt in Illinois, tell us at your first call. In our practice an Illinois injury is handled on a similar footing, with different paperwork.

One rule holds in both states. The bill is for care you received, and it is yours whether your case wins or loses. A lien changes when the bill is paid. It never changes whether it is owed. We say that before treatment starts.

When should surgery not wait?

Weakness that is getting worse, loss of bladder or bowel control, numbness in the groin or an unstable fracture go to an emergency department the same day.

Dr. Padda is a licensed physician and surgeon who performs image-guided procedures in our clinic. This is not an anti-surgery practice. When an operation is the right call, we say so plainly, and you walk into that surgical consult with a confirmed diagnosis and a body prepared to heal from it.

Not sure this is your problem? Take the 60-second candidacy check: am I a candidate?. Related: Workers’ comp second opinion before surgery.

Questions patients ask

Watch and read next

• Your Doctor Keeps Pushing Surgery: Questions to Ask First
• When the tissue has healed and the pain has not: whiplash and a sensitized system
• The clock starts on the day of the injury, not on the day of the diagnosis

Sources

1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015. doi:10.3174/ajnr.A4173 (PMID 25430861)
2. Barnsley L, Lord SM, Wallis BJ, Bogduk N. The prevalence of chronic cervical zygapophysial joint pain after whiplash. Spine (Phila Pa 1976). 1995. doi:10.1097/00007632-199501000-00004 (PMID 7709275)
3. Lord SM, Barnsley L, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study. Spine (Phila Pa 1976). 1996. doi:10.1097/00007632-199608010-00005 (PMID 8855458)
4. Revised Statutes of Missouri, sections 430.225 to 430.250 (health care provider liens). revisor.mo.gov